Position Overview
The Drug Rehabilitation Billing Specialist owns end-to-end revenue cycle operations for the substance use disorder portfolio, expanding as the portfolio grows. The role focuses on commercial out-of-network (OON) billing across detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
Core Responsibilities
— Submit claims end-to-end for detox, residential, PHP, and IOP levels of care across commercial OON payers
— Monitor claim status, work pending and rejected claims through the clearinghouse, and ensure timely resolution
— Conduct denial management, including root cause analysis and corrective resubmission
— Draft and submit appeals for OON denials and underpayments, coordinating with Utilization Review for clinical documentation
— Post ERAs and patient payments, reconcile against expected reimbursement, and surface underpayments for follow-up
— Coordinate with Utilization Review Directors and Patient Collections Managers at portfolio facilities
Required Experience
— Two to five years of hands-on substance use disorder billing experience
— Demonstrated experience with OON commercial billing, including OON benefits, billed charges, balance billing, and OON reimbursement dynamics
— Working understanding of single case agreements and their billing implications
— End-to-end revenue cycle competency including submission, follow-up, denial management, appeals, and payment posting
— Proficiency with UB-04 facility claims and CMS-1500 professional claims, including bill types, revenue codes, HCPCS codes, modifiers, and place-of-service codes for substance use disorder levels of care— Working knowledge of major commercial payers and their behavioral health carve-outs (e.g., Optum BH, Magellan, Evernorth, Carelon)
Preferred Qualifications
— Hands-on experience with EHRs, practice management systems, and clearinghouses (Sunwave / Waystar a bonus)
— Inpatient substance use disorder billing experience
— Experience billing for facilities operating in Florida or other heavily regulated substance use disorder markets
— Familiarity with Title 42 CFR Part 2 confidentiality requirements
— Prior experience at a back-office billing organization or in-house billing team at a multi-facility substance use disorder operator
— HIPAA workforce member experience and familiarity with PHI handling requirements